Following concerns about the use of mesh as part of the surgical treatment of vaginal prolapse and urinary incontinence, a Senate Inquiry into the number of women in Australia who have had transvaginal mesh implants and related matters was held. The report on its findings was released on 28 March 2018. ACT Health has incorporated the findings and recommendations of this report into our response.
On 30 November 2017, the Therapeutic Goods Administration removed a number of mesh products whose sole use is the treatment of pelvic organ prolapse via transvaginal implantation from the Australian Register of Therapeutic Goods. The TGA has established a Transvaginal (urogynaecological) surgical mesh hub webpage for consumers.
The Australian Commission on Safety and Quality in Health Care (the Commission) has developed a number of guidance documents for patients, clinicians and for health service organisations. More information can be found here.
The ACT Health response:
- Contact process (complete):
In 2018, ACT Health sent letters to all women who had been identified as having undergone surgery or treatment of this type at both Canberra Hospital and Calvary Public Hospital, within the past 20 years, to notify them of the issue and the options available to them if they were concerned.
- Review process (complete):
Women from the contact process who had concerns have been reviewed at both the Canberra Hospital and Calvary Public Hospital Gynaecology Outpatient Departments.
Ongoing use of TGA approved mesh ‘tapes’, ‘slings’ or ‘hammocks’ used for Stress Urinary Incontinence (SUI) by doctors credentialed to perform the procedures.
- ACT Pelvic Mesh Service
Canberra Health Services has established a dedicated multidisciplinary team-based service for ACT women experiencing complications that may be related to pelvic mesh. The team includes dedicated medical, nursing, pelvic physiotherapy and pain psychology staff.
Inclusion criteria, woman or person:
- Who underwent surgery for transvaginal mesh (TVM) in the ACT and are experiencing mesh related complications such as mesh erosion, pelvic pain, painful sex, abnormal vaginal bleeding and recurrent infections
- Who underwent surgery for TVM outside the ACT but now resides in the ACT
- Requesting/requiring review as part of the contact process conducted in the ACT who received a letter from an ACT health service in regards to having had a mesh procedure (letters sent 2018/19)
- Referrals for women who reside in areas surrounding the ACT will be considered (if travel to Sydney would be problematic).
NB. Transvaginal mesh includes polypropylene mesh used for pelvic organ prolapse and ‘slings’, ‘tapes’ or ‘hammocks’ used to treat stress urinary incontinence (SUI). Includes prospective SUI procedures using transvaginal mesh.
- Women who had transvaginal mesh related surgery in a state or territory outside of the ACT and who reside outside the ACT.
- Women who underwent surgery for pelvic organ prolapse or urinary incontinence but did not have transvaginal mesh or tape implanted during their surgery.
- Abdominal mesh
Accessing the service - Referrals should be addressed to ‘Dr Roopendra Banerji – Pelvic Mesh Clinic’ at the Gynaecology Outpatient Department at the Canberra Hospital. Fax referrals to (02) 5124 3834 (Gynaecology Outpatient Department, Centenary Hospital for Women and Children, Canberra Health Services).
Enquires: Phone: 5124 7474 (Admin support).Email: Meshreview@act.gov.au
General Practitioners are requested to include in their referral background information about the mesh procedure undertaken, surgeon and hospital (if known) and the current concerns or complications (e.g. erosion, infection, bleeding, pain). Please also include any investigations or information on related procedures.
NB. All patients requiring further investigation for potential mesh removal will be referred to the Urogynaecology Service at Westmead Hospital, Sydney.